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FACT SHEET: Rubella (also known as German measles or “three day measles”; caused by rubella virus, not the measles virus)

Date of Publication: March 11, 2013
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Is the initiation of non-invasive dental hygiene procedures* contra-indicated?

  • Yes, during the period of communicability (see below).

Is medical consult advised?  

  • Yes, if the patient/client is not already under medical care.

Is the initiation of invasive dental hygiene procedures contra-indicated?**

  • Yes, during the period of communicability (see below) and in the presence of significant morbidity.

Is medical consult advised? 

  • See above.

Is medical clearance required? 

  • No.

Is antibiotic prophylaxis required?  

  • No.

Is postponing treatment advised?

  • Yes, during the period of communicability (see below).

Oral management implications

  • Mode of transmission is via contact with nasopharyngeal secretions (including saliva, sputum, and nasal mucus) of infected people. Infection occurs by droplet spread (e.g., coughing and sneezing) or direct contact with patient/client. This highly communicable disease is contagious to others from about one week before and at least four days after onset of rash. Infants with congenital rubella syndrome (CRS) may shed large quantities of virus in their urine for months after birth.
  • Given long-standing provincial immunization programs, rubella is now very rare in Canada. However, unimmunized persons remain at risk of contracting rubella given potential contact with persons from other countries where rubella has not been eliminated or with certain religious communities which object to immunization. Infants born to immune mothers are usually protected for 6−9 months, depending on the extent of transplacental maternal antibody acquisition. 
  • MMR vaccine provides protection against measles, mumps, and rubella, while the MMRV vaccine also protects against varicella (chickenpox). In Canada, it is recommended that children (and unprotected adults) receive at least one dose of a combined rubella-containing vaccine. The first dose of the combined vaccine (for rubella protection) is usually given when children are one year old and the second (for enhanced measles protection) is given either when they are 18 months or before they start school (between ages 4 and 6 years); Ontario has adopted the school-entry regimen.  
  • Rubella immunization is particularly important for non-immune women of child-bearing age, because of the risks of miscarriage and serious birth defects. Healthcare workers, including dental hygienists, should ensure they are appropriately immunized. A simple blood test is available to determine immunity status and hence whether adult immunization is indicated.
  • If you, the dental hygienist, are pregnant and have never had rubella or the rubella vaccine, you should avoid contact with persons with rubella. The live attenuated vaccine is contraindicated in women who are pregnant or are trying to conceive. 
  • Persons with CRS are usually considered special needs patients/clients, and they may present with exaggerated dental and oral health problems due to lack of manual dexterity and/or focus by caregivers on other health challenges.

Oral manifestations

  • Unlike rubeola (measles), acute rubella infection does not usually result in pronounced oral findings. The oral mucous membranes are not usually inflamed, although the tonsils may be somewhat swollen and congested. Red macules may appear on the palate.
  • Congenital rubella syndrome does not tend to involve pronounced defects in deciduous or permanent dentition. However, missing teeth, enamel hypoplasia in primary and permanent teeth, narrow maxillary arch, and deep palate have been noted as infrequent congenital sequalae of CRS.

Related signs and symptoms

  • Due to routine immunization, rubella is no longer considered endemic in Canada, and thus the risk of contracting rubella in Canada is very low. However, rubella still occurs around the world, and imported cases occasionally surface in Canada. 17,407 cases of rubella were reported globally in 2022 (mostly in developing countries with low immunization rates), as well as 1,527 cases of congenital rubella syndrome.
  • Rubella usually presents as a mild febrile disease associated with a diffuse punctate and maculopapular rash, which lasts for several days. The red or pink rash tends to start on the face and then spread to the rest of the body. Post-auricular, occipital, and posterior cervical lymphadenopathy is a characteristic clinical feature, which precedes the rash by 5−10 days. Up to 50% of rubella infections are subclinical or without rash. 
  • Young children often have few symptoms beyond fever and sore throat, whereas adults may experience a 1−5 day prodrome of low-grade fever, headache, coryza (runny nose), conjunctivitis (pink eye), and general malaise. For children, rubella is usually a less serious disease than true measles.
  • Adults tend to have more complications than children, including arthralgia (i.e., sore, swollen joints) and, less frequently, arthritis, particularly in women. More rarely, encephalitis can occur. While thrombocytopenia (low platelet count) can also occur, hemorrhagic complications are very uncommon.
  • If a non-immune pregnant woman contracts rubella early in pregnancy, miscarriage may result. The fetus is also at risk of deafness, blindness, heart defects, brain damage, and liver and spleen damage.1 Overall risk of miscarriage in the first trimester of pregnancy is about 20%.

References and sources of more detailed information


Date: March 24, 2016
Revised: May 10, 2021; May 21, 2024


FOOTNOTES

1 The severity of systemic involvement depends on the stage of gestation in which maternal infection with rubella virus occurs.


* Includes oral hygiene instruction, fitting a mouth guard, taking an impression, etc.
** Ontario Regulation 501/07 made under the Dental Hygiene Act, 1991. Invasive dental hygiene procedures are scaling teeth and root planing, including curetting surrounding tissue.